Survival benefits of angiotensin-converting enzyme inhibitors in older heart failure patients with perceived contraindications
Survival benefits of angiotensin-converting enzyme inhibitors in older heart failure patients with perceived contraindications
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DOI：
10.1046/j.1532-5415.2002.50457.x
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发表时间：
2002-10-01
影响因子：
6.3
通讯作者：
DeLong, JF
中科院分区：
文献类型：
--
作者：
Ahmed, A;Kiefe, CI;DeLong, JF
目的：确定血管紧张素转换酶（ACE）抑制剂治疗与老年心力衰竭患者生存率之间的关系，这些患者的病情被医生视为ACE抑制剂的禁忌症。收缩压≤ 90 mmHg、血清肌酐≥ 2.5 mg/dL的住院老年心力衰竭患者，血清钾5.5 mmol/L或更高，或严重主动脉瓣狭窄。测量：出院后一年死亡率（根据各种患者和护理特征进行调整和未进行调整）。Logistic回归分析被用来估计对随后使用ACE抑制剂的禁忌症的影响。使用考克斯比例风险模型，估计出院后服用ACE抑制剂患者的1年死亡率的粗风险比（HR）和校正风险比（HR）及其95%置信区间（CI），并与未服用ACE抑制剂的患者进行比较。估计所有患者的HR，并重复分层后，患者的基础上存在的自觉禁忌症ACE抑制剂use.Results：的295例受试者，52（18%）的条件被认为是禁忌症，186（63%）收到ACE抑制剂，107（40%）在出院后1年内死亡。存在自觉禁忌症与出院时ACE抑制剂使用不足独立相关（校正OR=0.35，95%CI =0.17-0.71）。出院时服用ACE抑制剂与总体1年死亡率降低相关（HR=0.58，95% CI=0.40-0.85），对于（HR=0.34，95% CI =0.14-0.81）和无（HR=0.66，95% CI=0.42-1.02）自觉禁忌症。ACE抑制剂的使用与该队列中有明显禁忌症的住院老年心力衰竭患者的生存获益相关。
Objectives: To determine the association between angiotensin-converting enzyme (ACE) inhibitor therapy and survival of older heart failure patients with conditions perceived by physicians as contraindications to ACE inhibitors.Setting: Hospital.Design: Retrospective follow-up study.Participants: Hospitalized older heart failure patients with systolic blood pressure of 90 mmHg or less, serum creatinine of 2.5 mg/dL or more, serum potassium of 5.5 mmol/L or more, or severe aortic stenosis.Measurements: One-year postdischarge mortality (with and without adjustment for various patient and care characteristics). Logistic regression analyses were used to estimate the effect of the perceived contraindications on subsequent use of ACE inhibitors. Using Cox proportional hazards models, crude and adjusted hazard ratios (HRs) of 1-year mortality with 95% confidence intervals (CIs) were estimated for patients discharged on ACE inhibitors and compared with those without. HRs were estimated for all patients and were repeated after stratifying patients based on the presence of perceived contraindications to ACE inhibitor use.Results: Of the 295 subjects, 52 (18%) had conditions perceived as contraindications, 186 (63%) received ACE inhibitors, and 107 (40%) died within 1 year of discharge. Presence of a perceived contraindication was independently associated with underutilization of ACE inhibitors on discharge (adjusted OR=0.35, 95% CI=0.17-0.71). ACE inhibitor prescription at discharge was associated with lower 1-year mortality overall (HR=0.58, 95% CI=0.40-0.85) and for the groups of patients with (HR=0.34, 95% CI =0.14-0.81) and without (HR=0.66, 95% CI=0.42-1.02) perceived contraindications.Conclusions: ACE inhibitor use was associated with a significant survival benefit in this cohort of hospitalized older heart failure patients with perceived contraindications.